Provider Demographics
NPI:1841246360
Name:THORSEN COHEN, CLARA LOUISE (CRNA)
Entity Type:Individual
Prefix:
First Name:CLARA
Middle Name:LOUISE
Last Name:THORSEN COHEN
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CLARA
Other - Middle Name:LOUISE
Other - Last Name:THORSEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:111 E 210TH ST
Mailing Address - Street 2:
Mailing Address - City:BRONX
Mailing Address - State:NY
Mailing Address - Zip Code:10467-2401
Mailing Address - Country:US
Mailing Address - Phone:718-920-4316
Mailing Address - Fax:718-881-2245
Practice Address - Street 1:111 E 210TH ST
Practice Address - Street 2:
Practice Address - City:BRONX
Practice Address - State:NY
Practice Address - Zip Code:10467-2401
Practice Address - Country:US
Practice Address - Phone:718-920-4316
Practice Address - Fax:718-881-2245
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2019-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDN29356163W00000X
IDRNA455A367500000X
NY442484367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID430061691OtherRAILROAD MEDICARE
ID805924700Medicaid
ID1603264Medicare PIN